These are not "guidelines" in the traditional sense of a systematic review of the literature with pre-defined acceptance/rejection criteria and a standardized grading scale for literature articles, with subsequent listing in the national guideline clearinghouse. These are more of a "interventional society committee best practices book" with heavy input by one individual. It has significant value but is not a "guideline" in the traditional sense. The author in the preface notes he is not using the term "guideline" in the sense that is generally recognized by governments and others, but is parsing the term to mean effectively a cookbook on how to technically perform procedures without deference to whether the procedures should be performed or not, and without consideration of whether payment will be rendered or not. Ergo, simply because it is in the book means neither that the procedure is appropriate for a given patient nor implies that there will be reimbursement.
It is an excellent treatise of one pain society's collective experience in the performance of injections. There is an underlying consistency, if not overt immutability of procedure performance over time, taught by disciples of the founders of the society that have adopted the procedures into their practice, then teach other disciples the same techniques with propagation through generations of pain physicians via educational courses and "guidelines" that are taken by some of these disciples as the standard of care. It is the latter point where caution must be taken. The "guidelines" are not standards of care nor have they engaged a comparative study of the several techniques of performance. They instead represent an excellent book for one technique of performance incorporated by generations of physicians taught the same techniques over and over throughout the years. It is also a very rich resource of anatomical detail for procedure performance with outstanding radiographic images and diagrams. The techniques included in courses have been largely driven by the "guidelines" and in the absence of "guidelines", several techniques that were previously taught were removed from the courses in the past. It has been argued that the society moved glacially slowly in teaching of techniques in the absence of publication of the techniques in "guidelines" that have only been published twice since the founding of the society two decades ago. There are both pros and cons to this approach but in general, this conservatism is proven to be warranted, as long as the pain physician recognizes the "guidelines" are a "societal committee best practices" book, and should not preclude other techniques from being employed when indicated.
